Retrospective review of intra- and post-operative complications with minimal versus large space of Retzius infiltration at the time of retropubic TVT placement

Ras, Lamees; Roskam, Suzanne Frederika Nicoline; Kruger, Petrus Frans; Jeffery, Stephen

doi:10.1007/s00192-018-3730-3

Cited by 4 publications

(6 citation statements)

References 6 publications

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“…Some authors suggest various modifications of the TVT procedure to reduce the risk of cystotomy. Ras et al [25] reported a beneficial effect of a large (2 × 180 ml of saline with bupivacaine and adrenaline) bilateral space of Retzius infiltration. McLennan et al [26] proposed an abdominal needle placement (top-down) instead of the vaginal (bottom-up) approach.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Szymański

Zaręba

Jakiel

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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Introduction: The midurethral sling has become the current standard for the treatment of female stress urinary incontinence. Aim: To assess intraoperative complications, early post-operative complications as well as the efficacy of tension-free vaginal tape: retropubic and trans-obturator tape procedures. Material and methods: The analysis involved 91 tension-free vaginal tape (TVT) and 60 transobturator tape (TOT) procedures. Both groups were comparable in terms of patient characteristics, urodynamic results, and preoperative quality of life (QoL) assessment. The complications were registered, and the effectiveness of the procedures was assessed subjectively by the patients at 1-, 3-, 6-and 12-month follow-up. Results: A significantly lower risk of intraoperative and early post-operative complications was noted in the case of TOT procedures (OR = 0.35%, 95% CI: 0.13-0.92). Moreover, regardless of the method used, patients with two or more vaginal deliveries in their history had a reduced risk of complications, as compared to nulliparas and uniparas (OR = 0.38%, 95% CI: 0.16-0.91). Previous gynaecological surgery and old age increase the risk of complications with borderline significance (OR = 2.5, 95% CI: 0.97-6.3; OR = 2.3, 95% CI: 0.95-5.5 respectively). The rates of cure, improvement and failure were similar in both groups, as was the significant positive change in post-operative life quality. Conclusions: TVT and TOT procedures are characterised by a high cure rate and improvement in the post-operative quality of life. However, it seems that the transobturator approach should be the preferred method of treatment of SUI due to the reduced risk of complications, shorter procedure time, and lower intraoperative blood loss.

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Section: Discussionmentioning

confidence: 99%

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Szymański

Zaręba

Jakiel

et al. 2019

Videosurgery and Other Miniinvasive Techniques

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“…In this study, which prospectively followed 149 patients undergoing R-MUS placement, retropubic hydrodissection did not significantly reduced bladder perforation rates 10 —a finding echoed in our study. In a more recent publication by Ras et al, 11 comparing bilateral retropubic injections of small (<70 mL per site) and large volume (180 mL per site), trocar-related bladder injury only occurred in the small volume group; however, this study was limited by sample size and lacked power to give procedure-related recommendations to avoid bladder injury. Although these injected volumes were much larger than those originally described by Ulmsten and Petros, 2 our data, which is based on a large cohort of patients, do not support the recommendation to inject before trocar placement to prevent trocar-related bladder injury.…”

Section: Discussionmentioning

confidence: 86%

“…9 Given conflicting evidence regarding predictive factors for bladder perforation during R-MUS placement, and lack of evidence to support adoption of techniques to minimize such injury, studies are needed to further elucidate factors predictive of bladder injury. 10,11 Thus, the primary objective of our study was to describe the incidence of and factors associated with bladder perforation at the time of R-MUS placement. Secondary objectives were to examine the effect of retropubic hydrodissection on rates of bladder perforation and to describe whether patients who experience a trocar-related bladder injury experience a higher incidence of other adverse events.…”

mentioning

confidence: 99%

“…Given conflicting evidence regarding predictive factors for bladder perforation during R-MUS placement, and lack of evidence to support adoption of techniques to minimize such injury, studies are needed to further elucidate factors predictive of bladder injury 10,11 . Thus, the primary objective of our study was to describe the incidence of and factors associated with bladder perforation at the time of R-MUS placement.…”

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confidence: 99%

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Risk Factors for Bladder Perforation at the Time of Retropubic Midurethral Sling Placement

Casas-Puig

Bretschneider²,

Walters³

et al. 2022

UROGC

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ImportanceThere is conflicting evidence regarding predictive factors for bladder perforation during retropubic midurethral sling (R-MUS) placement and lack of evidence to support adoption of techniques to minimize such injury.ObjectivesThe aims of the study were to describe the incidence of and factors associated with bladder perforation during R-MUS placement and to explore whether retropubic hydrodissection decreases the likelihood of perforation.Study DesignThis is a case-control study of women undergoing R-MUS placement from 2007 to 2017. Cases were identified by review of the operative reports for evidence of bladder perforation. Patients without bladder perforation were defined as controls and were matched to cases in a 3:1 ratio by surgeon, sling type, and surgery date.ResultsA total of 1,187 patients underwent R-MUS placement. The incidence of bladder perforation was 8% (n = 92 patients); 276 controls were matched accordingly (N = 368). Patients with bladder perforations were more likely to have a body mass index (BMI) less than 30 (P = 0.004) and to have a diagnosis of endometriosis (P = 0.02). They were also more likely to have had previous hysterectomy (P = 0.03) and urethral bulking (P = 0.01). On logistic regression, bladder perforation remained associated with a BMI less than 30 (adjusted odds ratio, 2.22 [95% confidence interval, 1.30–3.80]) and endometriosis (adjusted odds ratio 2.90 [95% confidence interval, 1.15–7.01]). Retropubic hydrodissection was performed in 62% of the patients and was not associated with a lower risk of perforation (P = 0.86).ConclusionsThe incidence of bladder perforation was 8%. The risk of this complication is higher in patients with a BMI less than 30 and/or endometriosis. Retropubic hydrodissection may not decrease the likelihood of this event.

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“…In addition, iatrogenic bladder injury may result in increased postoperative pain, urinary retention, urinary tract infections, and retropubic hematoma. 4,5 Unrecognized bladder perforation can lead to postoperative dysuria, recurrent urinary tract infections, urinary frequency, urgency, pelvic pain, and bladder calculi on exposed sling material. Unrecognized iatrogenic bladder injury requires additional revision surgery with at least partial mesh sling removal and can result in a return of SUI.…”

Section: Openmentioning

confidence: 99%

C-Clamp Technique: A Retrospective Review of a Novel Technique to Prevent Bladder Injury in Retropubic Midurethral Slings

Jayne¹,

Bach²,

Odulate-Williams

et al. 2023

UROGC

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Importance Synthetic mesh midurethral slings have become the criterion-standard treatment for stress urinary incontinence with urethral hypermobility in women. Iatrogenic bladder injury is a known risk of the procedure. Objective Our objective was to show that a novel "C-clamp technique" can significantly reduce the risk of bladder and urethral injury at the time of bottom-up retropubic synthetic mesh midurethral sling placement. Study Design We conducted a retrospective review of the electronic medical records using Current Procedural Terminology coding of a single surgeon who performed synthetic mesh midurethral slings. Medical records were reviewed for demographic and clinical data for all bottom-up retropubic synthetic mesh midurethral slings placed using a novel C-clamp technique. All operative reports were reviewed for bladder and urethral injury at the time of implantation of the synthetic mesh midurethral sling using the C-clamp technique. Results Two hundred one consecutive bottom-up retropubic synthetic mesh midurethral slings were placed using the C-clamp technique from April 2012 through June 2022. The average age was 51 years (29-86 years); the average weight was 82 kg (46 -139 kg); and the average body mass index was 31 kg/m 2 (15-57 kg/m 2 ). No patients sustained a bladder or urethral injury at the time of implantation of a retropubic synthetic mesh midurethral sling using the C-clamp technique. Conclusion The novel C-clamp technique shows promise in eliminating the risk of iatrogenic bladder and urethral injury at the time of implanting a bottom-up retropubic synthetic mesh midurethral sling.

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Retrospective review of intra- and post-operative complications with minimal versus large space of Retzius infiltration at the time of retropubic TVT placement

Abstract: This retrospective review revealed the potentially beneficial effect of the large (180 ml × 2) bilateral SORI with retropubic TVT placement in terms of the reduction in risk of bladder perforation. It also showed no potential added risk of post-operative complications.

Cited by 4 publications

References 6 publications

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Intraoperative and early postoperative complications in women with stress urinary incontinence treated with suburethral slings: a randomised trial.

Risk Factors for Bladder Perforation at the Time of Retropubic Midurethral Sling Placement

C-Clamp Technique: A Retrospective Review of a Novel Technique to Prevent Bladder Injury in Retropubic Midurethral Slings

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